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Description of the Evidence


A study of the feasibility of single-visit management of high-grade cervical lesions was conducted among a predominantly Latina population in California.[69] Women were randomly assigned to a single-visit group (n = 1,716) in which the Pap test was evaluated immediately and treatment administered the same day for women with HSIL or atypical glandular cells of undetermined significance (AGUS) results; or to usual care (n = 1,805), with results of the Pap test provided within 2 to 4 weeks and referrals for treatment based on results. The program was feasible, with a high degree of acceptability and results in 14 of 16 (88%) women with abnormal test results completing treatment by 6 months versus 10 of 19 (53%) women in the usual care arm completing treatment by 6 months. Follow-up at 12 months was also higher among women in the single-visit group with HSIL/AGUS than among those in the usual-care arm; among all women, only 36% in each group had a follow-up Pap test at 1 year.

Self-collected HPV testing may be an alternative method for cervical screening in communities with limited access to health care providers. A pooled analysis of cervical screening studies conducted in China compared sensitivity and specificity of self-collection of cervical specimens for HPV DNA testing, physician-collected specimens for HPV testing, liquid-based cytology (LBC) and visual inspection of the cervix with acetic acid (VIA). The study included 13,004 participants in the analysis. Women had all three sampling methods; in one study included in the pooled analysis, all women had colposcopy and biopsies. Of note, the women were instructed in the self-collection methodology by physicians, which likely affected the quality of specimen collection and thus the accuracy of the test in these studies. Physician-collected specimen HPV DNA testing had the highest sensitivity 97% for CIN 2+ (95% CI, 95.2%–98.3%) and 97.8 for CIN 3+ (95% CI, 95.3%–99.2%). Self-collected specimen HPV testing had moderate agreement with physician-collected specimen testing (k = 0.67). Pooled sensitivity for self-collected HPV testing was 86.2% for CIN 2+ (95% CI, 82.9%–89.1%) and 86.1% for CIN 3+ (95% CI, 81.4%–90.0%). Pooled specificity for self-collected HPV DNA testing was 80.7% (95% CI, 75.6%–85.8%) for CIN 2+ and 79.5% (95% CI, 74.1%–84.8%) for CIN 3+. The specificity of HPV testing was lowest of all screening modalities. Whereas pooled sensitivity was highest for physician-based HPV testing, it was lowest for the VIA screening methods—50.3% for CIN 2+ and 55.7% for CIN 3+. Pooled specificity was highest for LBC—94.0% for CIN 2+ and 92.8% for CIN 3+.[70]


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